What is the recommended rehabilitation plan for a patient who underwent total hip replacement surgery on the left side via the lateral approach and is now walking and climbing stairs well?

Rehabilitation Plan for Total Hip Replacement (Left Side, Lateral Approach)

Current Status and Progression

Since you are already walking and climbing stairs well post-operatively, you should now focus on a structured strengthening and functional exercise program for 9-12 months total from surgery to optimize long-term outcomes and prevent complications. 1

Your current functional status indicates successful early recovery, but continued rehabilitation is essential to restore full hip power generation, prevent compensatory movement patterns, and maximize quality of life outcomes.

Structured Exercise Program Components

Strengthening Exercises (Priority Focus)

• Perform daily individualized strengthening exercises targeting both legs, including sustained isometric exercises for the quadriceps and proximal hip girdle muscles (gluteal muscles), regardless of which side was operated 1
• Progress to concentric and eccentric strengthening exercises as tolerated without pain or effusion 1
• Include both closed kinetic chain exercises (squats, leg press, step-ups) and open kinetic chain exercises to restore hip power production, which research shows is improved after THA but requires continued training 1, 2
• Aim for strengthening sessions at least 3 days per week, building up intensity over several months using the principle of "small amounts often" 1

Aerobic and Functional Training

• Incorporate regular aerobic activity such as walking, cycling, or elliptical training to improve cardiovascular fitness and overall function 1
• Continue and advance stair climbing practice, as your hip joint now needs to generate more power during this activity compared to level walking 2
• Progress to sport-specific or work-specific functional activities based on your individual goals, recognizing that higher-intensity activities do not increase revision rates when properly conditioned 3

Range of Motion and Flexibility

• Perform daily stretching exercises for the hip, including hip flexors, extensors, abductors, and rotators to maintain and improve range of motion 1
• Include adjunctive range of movement exercises as part of your daily routine, linking them to other activities (e.g., before morning shower) to ensure consistency 1

Important Precautions for Lateral Approach

Movement Restrictions

• Avoid excessive hip adduction (crossing the operated leg past midline) as the lateral approach involves partial detachment of hip abductor muscles 4
• Be cautious with combined movements of hip flexion beyond 90 degrees with internal rotation, particularly in the first 3 months
• Monitor for any hip abductor weakness or Trendelenburg gait pattern, which can occur with lateral approach 5

Pain and Symptom Monitoring

• Discontinue or modify exercises if you experience unusual or persistent fatigue, increased weakness, decreased range of motion, or pain lasting more than one hour after exercise 1
• Some activities may be associated with increased hip pain even after successful THA (such as tennis, squash, or backpacking), while others are better tolerated (swimming, cycling, cross-country skiing) 3

Rehabilitation Timeline and Milestones

Current Phase (Already Achieved)

• Full weight-bearing without assistive devices ✓
• Independent stair climbing ✓
• Basic functional mobility restored ✓

Next 3-6 Months Focus

• Maximize hip abductor and extensor strength to restore normal gait mechanics and prevent compensatory patterns 2, 5
• Progress resistance training intensity gradually, monitoring for any adverse reactions
• Achieve symmetrical hip power generation during walking and stair climbing compared to the non-operated side 2

6-12 Months Goals

• Complete restoration of hip power production during all functional activities 2
• Return to desired recreational activities or physically demanding work with appropriate conditioning 3
• Maintain regular self-directed exercise program for long-term joint health 1

Additional Supportive Measures

Weight Management and Lifestyle

• If applicable, maintain healthy body weight through regular self-monitoring, structured meal planning, and increased physical activity to reduce stress on the hip joint 1
• Consider joining structured exercise classes or programs at local fitness facilities for social support and adherence 1

Assistive Devices and Home Modifications

• Ensure appropriate home modifications remain in place: elevated toilet seats, handrails for stairs, and removal of trip hazards 1
• Use comfortable, supportive footwear during all activities 1

Common Pitfalls to Avoid

• Do not assume that pain-free walking means rehabilitation is complete—gait anomalies and reduced hip power can persist even years after surgery without continued strengthening 5
• Avoid rapid progression to high-impact activities without adequate conditioning, even though research shows they don't increase revision rates when properly prepared 3
• Do not neglect the non-operated leg—bilateral strengthening is essential as the contralateral limb often compensates during recovery 1, 2
• Avoid discontinuing exercise once initial goals are met; long-term adherence to regular exercise is critical for maintaining outcomes 1